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ACKNOWLEDGMENTS
:
M K W M
C E M R, W H O.
T 7 G C H
P, "P H D: C I G", N, K,
2630 O 2009.
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, WHO
.
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P 2
CONTENTS
L A........... ..................... ...................... ..................... ..................... ...................... .................... ...................... ............ 2
E S.................... ..................... ...................... ...................... .................... ...................... .................... ......... 4
F..... ...................... ..................... ...................... ...................... .................... ...................... ..................... ...................... ............... 8
W ?...................... ..................... ...................... .................... ...................... ...................... .................... ...................... ..... 9
W ?.......................... ..................... ...................... .................... ...................... ..................... ..................... ...... 10
W ? .................. ...................... ...................... .................... ...................... ..................... ............. 16
1. T ..................... ...................... ...................... .................... ...................... ......... 16
2. R ............................ ...................... ..................... ..................... ...................... ............ 19
3. I ................... ...................... ...................... .................... ...................... ................ 21
4. H .................... ..................... ...................... ...................... .................... ...................... .................... .......... 23
5. H ..................... ..................... ...................... .................... ...................... ...................... ..... 24
6. E..................... ...................... .................... ...................... ..................... ..................... ..................... ...................... ......... 25
H ?....... ...................... ...................... .................... ...................... .. 26
W ? ...................... ..................... ..................... ............. 28
H ?.............................. ...................... .................... ...................... ...................... ..................... .. 33
W ?.......................... ...................... .................... ...................... .................... 35
W EMRO ? ................... ................. 37
M .................... ...................... ..................... ...................... .................... ...................... ..................... ..................... ................. 38
O F .................... ...................... ...................... .................... ...................... ...................... .................... .......... 38
S F ................... ..................... ...................... ...................... .................... ...................... ..................... .................... 39
G R......................... ..................... ...................... .................... ...................... ..................... ............. 41
N S.................... ..................... ..................... ...................... .................... ...................... ..................... ..................... ................. 42
A 1. M S R H L, B O ................... .................... 44
A 2. S R E S ................... ...................... ..................... ...................... ................ 46
LIST OF ABBREVIATIONS
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P 3
CQI C Q I
HIV H I V
NCD N /
PDSA P/D/S/A
R
SEAR/SEARO S E A R/ S E A R O
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EXECUTIVE SUMMARY
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FORWARD
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WHAT IS LITERACY?
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FIGURE 1. GLOBAL LITERACY RATES BY COUNTRY
WHAT IS HEALTH LITERACY?
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FIGURE 2. HEALTH LITERACY FRAMEWORK DEVELOPED BY THE US INSTITUTE OF
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FIGURE 3. FACTORS AND CONTEXTS THAT INFLUENCE HEALTH KNOWLEDGE, DECISIONS
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10P, R., & K, D. (2006). B I M H L R: A R B T S? J G I M, 21(8): 891892.://.../.?=1831577
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Access orexposureto health
information
Understandhealth
information
Appraisehealth
informationCommunicate
healthinformation
Health knowledge
GeneralReading
WritingListeningSpeakingNumeracy
Other
ScientificComputerCultural
Media
Literacy
H e a l t h I n f o r m a t i o n C o n t e x t
Health
decisions
Healthactions
Outcomes
PersonalValues, attitudes, beliefs,
knowledge, motivation, skills,behaviour, personal capacity,
biology, previous life experiences,
current physical and psychological state
External
Income, social status,social support, education system,health system, social environment,employment and working conditions,physical environment, culture,communication systems, research,
economic environment
Other Factors
(Factors with respect to the individual seeking information,
the sources of information, and the information itself)
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20N, D. (2000). H : A 21. H P I, 15, 259267.
21 Nutbeam , D. (2000) Health literacy as a public health goal: a challenge for contemporary health education andcommunication strategies into the 21
stcentury. Health Promotion International, 15(3):259267.
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FIGURE 4. APPROACHES TO CONCEPTUALIZING HEALTH LITERACY
Approach Focus Description
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39S RL, Y K, S S, H TB, M KM, S EM.(2006). L : , , . J G I M;21:80612.
40W MV, B DW, P RM, N JR.(1998). R
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41 W MS, D TC, T HH, B PF, P RM.(2006). M
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42W MV, B DW, P RM, N JR.(1998). R : . A I
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43DW DA, B ND, S S, L KN, P MP. (2004). L . J G IM ;19:122839.
44W MS, D TC, T HH, B PF, P RM.(2006). M . A J HS P;63:104855.
45B, D., W, M., F, J., T, J., G, J., H,J. (2007). H L MAE P. .167(14):15031509
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FIGURE 7. RELATIONSHIP BETWEEN LITERACY LEVEL AND MORTALITY
( = 3260 M )
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53NB, L., P, A., K, D. (E, C H L, I M (IOM)).
(2004). H L: A P E C. N A S. W, DC.
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4. HEALTH CARE COSTS
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60R RE, C T, S R. 2000. A O M P H L A L
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FIGURE 9. FACTORS AND CONDITIONS THAT INFLUENCE LITERACY RATES
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63R, I., & R, B. (2003) L H C: W W H L W C H
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64von Wagner, C., Knight, K., Steptoe, A., & Wardle, J. (2007). Functional health literacy and health promoting
behaviour in a national sample of British adults. J Epidemiol.Community Health, 61,
65://...//P/H/H/DH095382
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68N, D. (1998) H . H P I, 13, 349364
69P, R.M., B, D.W., W, M.V., N, J.R. (1995) T F H L A:
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70US N N L M H P 2010 (2000).
71A, T., (2008). M : , I J PH 53 (2008) 169170
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FIGURE 10. HEALTH LITERACY FRAMEWORK US INSTITUTE OF MEDICINE (2004)
76I
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82Parker, R., & Kindig, D. (2006) Beyond the Institute of Medicine Health Literacy Report: Are the Recommendations
Being Taken Seriously? J Gen Intern Med. August; 21(8): 891892http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1831577
83A R, I. & EB, D.(2008). , O: CPHA.
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FIGURE 11. CANADIAN PUBLIC HEALTH ASSOCIATION EXPERT PANEL MODEL OF HEALTH
LITERACY
G ,
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84G, D. (2006).
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FIGURE 12. HEALTH LITERACY FRAMEWORK (GILLIS 2006)
Health
EnhancingOutcomes
Health Promoting
Interventions
Health
Literacy
Basic/Functional
Literacy
Communicative/
Interactive Literacy
Critical Literacy
PersonalEmpowerment
DEG 13/06/06
Provider Practice:e.g. nature of client/provider rel.,communication skills, resources
Health Decisions
Health Actions
Health Advocacy
Health
Outcomes
HealthStatus
Health CareCosts
Social Determinants of Health:
e.g. level of literacy, education, income, ethnicity,employment, age, social support, culture, gender
Situations & Contexts
N
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FIGURE 13. CONCEPTUAL MODEL OF HEALTH LITERACY AS AN ASSET (NUTBEAM 2008)
85 N, D. (2008). T . S S & M, V 67, I 12,
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R U V
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FIGURE 14. HEALTH LITERACY CONCEPTUAL FRAMEWORK (ROOTMAN, 2009)
86R, I. (2009). H L: W W D A I? P U V,
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87G, D., Q, A. (2004). T : S .
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General LiteracyReading ability
NumeracyListening and Speaking ability
Comprehension ability
Negotiation skills
Critical thinking& judgement
Literacy
Workenvironment
Stresslevel
Income
Health
Status
Quality
Of
Life
Lifestyles
Effects of Literacy
Organizational
Development
Communication
CapacityDevelopment
CommunityDevelopment
Actions
Determinants
Use of services
Direct(Medication use,
Compliance,safety practices.)
Indirect
Indirect
Health Literacy
Ability to find, understand and
communicate health informationAbility to assess health information
Other LiteracyScientific, Computer,
Cultural, MediaEtc.
Policy
Education
Early Child
Development
Aging
PersonalCapacity
Living/WorkingConditions
Gender
Culture
HOW IS HEALTH LITERACY MEASURED?
O , ,
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88 R E A L M
(REALM), T F H L A (TOFHLA), H A L S
(HALS), N V S (NVS), S I R A C T (SIRACT),
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88 P, A. (2009). M : A .
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89Agency for Health Care Research and Quality (AHRQ) (2007, Feb. 9, 2007). CAHPS health literacy item set. Retrieved July 16,
2007, from http://www.cahps.ahrq.gov/content/products/HL/PROD_HL_Intro.asp
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91Baker, D (2006). The meaning and the measure of health literacy.Journal of General Internal Medicine, 21: 878-83.
92R, I. (2009) H L: W ? U V .
93R, I. (2009). H L, W ? P F E
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44
ANNEX 1. MAJOR SYSTEMATIC REVIEWS OF HEALTH LITERACY, BEHAVIOURS
AND OUTCOMES
Pignone, et al., 2005120
Method: Systematic review of research publishedbetween 1980-2003 on the effect of interventions on the
health outcomes of persons with low health literacy.
Included controlled and uncontrolled trials that measured
literacy and examined the effects of interventions for
people with low literacy on health knowledge, healthbehaviours, use of health care resources, intermediate
markers of disease status, and morbidity or mortality.
Findings: Only 5 articles examined the interaction
between literacy level and the effect of the intervention.
Mixed results.
Conclusions: Drawing conclusions difficult because oflimitations in study design, interventions tested and
outcomes assessed. Further research required.
Hauser and Edwards, 2006121
Method: Reviewed research on health literacyinterventions published prior to 2007
Findings: Few rigorous evaluations exist. While mostwidespread initiative used is simplifying reading material
using clear language and pictures, there is no evidence that
this improves health outcomes. Although multimedia
presentations may improve knowledge in both the literate
and the less literate, they do not appear to change health-
related behaviours.
Conclusions: Community development is a promising
avenue that requires more exploration. Creation of
innovative evaluation tools required.
King, 2007122
Method: Review of published and grey literature related
to health literacy interventions in Canada and
internationally. Also conducted key informant interviews.
Findings:
Majority of health literacy interventions to
involve accessing and understanding, with very few
focused on appraising or communicating health
information. Very limited information found on theeffectiveness of health literacy interventions. Some
evidence exists to support the finding and generalunderstanding that a participatory educational and
empowerment approach is effective.
Conclusions:
Barriers to evaluation of programs were
time, money and lack of provider expertise. Further
investigations suggested :
health literacy interventions focused onappraising health information
cultural issues health care professional training
sources of health information
learner and patient perspectives
Clement et al., 2009123
Method: Systematic review of randomized and quasi-
randomized controlled trials that focused on complex
interventions for people with limited literacy or numeracy.
Searched eight databases from 1966 to 2007.
Predominantly North American.
Findings: Knowledge and self-efficacy were outcomes
most likely to improve but not necessarily related tohealth outcomes.
Conclusions: While the review focused on two specific
aspects of health literacy (reading ability and numeracy)
many interventions included wider empowerment and/or
community participation aspects. The implementation of
literacy/numeracy interventions might most usefully be
embedded within this broader approach to health literacy.
120P,M., DW, D., S, S., B, N., & L, K. (2005). I I H O
P L L: A S R. J G I M. 20, 2. 185192
121H, J. & E, P. (2006). , : O: E P
H L, C P H A.
122K, J. (2007). E S I I H L. N C
C D H
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45
123C, S., . . ((2009). C I : A
. P E C. 75, 340351.
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ANNEX 2. STUDIES REVIEWED IN ENVIRONMENTAL SCAN
J H B S P H: C C P (2005).
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H C P (2007). C H L C I
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H C P (2001). A W S O (AWSO) P H A
W R L. C I, N 13.
O, H., C, M., W, L., N, A., & S, M. (2008). P I: C ?. A U B, F H S.
J H B S P H: C C P (2005). J
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Y 19992003. ://..///.
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R L (RL) L W. ://..///.
H C P (2003). M J G I T H
F. C I, N 14. ://..///.
Z, D. (2007). C A HC C C H P:
C I D C A A A P.
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B, S.A., A, M.A., H, A.A., A, S.M., A, H., B, H.,
B, M., P, S. & R, S.F. (2007). H :
I. J M E D C; 4(1), 19.